Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer
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View abstract on PubMed
Summary
This summary is machine-generated.Frailty assessment in older adults with advanced non-small cell lung cancer (aNSCLC) receiving systemic therapy predicts overall survival and adverse events. Frailty indices are more comprehensive than Karnofsky Performance Status (KPS) for identifying at-risk patients.
Area Of Science
- Geriatric Oncology
- Thoracic Oncology
- Clinical Geriatrics
Background
- Frailty indices are established predictors of overall survival (OS) and toxicity in older adults undergoing chemotherapy.
- The increasing use of immunotherapy and targeted therapy in advanced non-small cell lung cancer (aNSCLC) necessitates evaluating frailty and performance status in this population.
Purpose Of The Study
- To assess the association between frailty and Karnofsky Performance Status (KPS) with overall survival (OS), hospitalizations, functional decline, and toxicity in older adults with aNSCLC receiving systemic therapies.
- To compare the predictive value of a deficit-accumulation frailty index against KPS for clinical outcomes.
Main Methods
- A prospective cohort of 155 patients aged 65 and older with aNSCLC receiving non-curative systemic therapy underwent geriatric assessments.
- A deficit-accumulation frailty index was developed to classify patients as robust, pre-frail, or frail.
- Cox proportional hazards models and logistic regression were used to analyze associations between frailty, KPS, and outcomes, adjusting for covariates.
Main Results
- Among 155 patients (median age 73), 18.2% were frail, 36.1% pre-frail, and 45.8% robust. Median OS was 17.9 months.
- Pre-frail/frail patients had significantly worse OS (aHR 2.09) and higher likelihood of hospitalization (aOR 2.21), functional decline (aOR 2.29), and grade ≥3 hematologic toxicity (aOR 5.18) compared to robust patients.
- Karnofsky Performance Status (KPS) was only associated with OS, not other adverse events.
Conclusions
- A frailty index effectively predicts OS, hospitalization, functional decline, and hematologic adverse events in older adults with aNSCLC on systemic therapy.
- KPS demonstrated a weaker association with outcomes, being linked only to OS.
- Pretreatment frailty assessment is valuable for identifying older adults at risk of poor outcomes, aiding in treatment decision-making and supportive care optimization.
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